Impact of a structured yoga program on blood pressure reduction among hypertensive patients: study protocol for a pragmatic randomized multicenter trial in primary health care settings in Nepal

Abstract

BackgroundHypertension control remains a major global challenge. The behavioral approaches recommended for blood pressure reduction are stress reduction, increased exercise and healthy dietary habits. Some study findings suggest that yoga has a beneficial effect in reducing blood pressure. However, the role of yoga on blood pressure has received little attention in existing health care practices in developing countries. This study will be conducted in primary health care facilities in Nepal to assess the effectiveness of a pragmatic yoga intervention to complement standard practice in further reducing blood pressure.MethodsThis will be multicentric, two arms, randomized, nonblinded, pragmatic trial. It will be conducted in seven District Ayurveda Health Centers (DAHCs) in Nepal between July 2017 and June 2018. The study participants will consist of hypertensive patients with or without antihypertensive medication attending to the outpatient department (OPD). One hundred and forty participants will be randomized to treatment or control groups by using a stratified block randomization. At the study site, the treatment arm participants will receive an intervention consisting of five days of structured yoga training and practice of the same package at home with a recommendation of five days a week for the following 90 days. Both the intervention and control groups will receive two hours of health education on lifestyle modifications. The primary outcome of this trial will be the change in systolic blood pressure and it will be assessed after 90 days of the intervention.DiscussionThis study will establish the extent to which a yoga intervention package can help reduce blood pressure in hypertensive patients. If proven effective, study findings may be used to recommend the governing bodies and other stakeholders for the integration of yoga in the national healthcare system for the treatment and control of hypertension.Trial registrationClinical Trial Registry- India (CTRI); CTRI Reg. No- CTRI/2017/02/007822. Registered on 10/02/2017.

Effects of a health worker-led 3-month yoga intervention on blood pressure of hypertensive patients: a randomised controlled multicentre trial in the primary care setting

“…A total of 121 hypertensive participants were recruited and allocated to intervention ( n = 61) and control ( n = 60) groups using the above-mentioned randomisation method. As per the published intervention protocol, the target sample size for the trial was 140 participants [ 20 ]. However, we managed to recruit 121 participants during the study period (Additional file 1 ).…”

“…The instructors were also permanent public employees, and they agreed to implement the study without altering their usual work routines at the centres. Among the seven trial centres, AHCs located in Kaski, Nuwakot, and Surkhet were able to recruit the initially planned number of participants ( n = 20) during the study period [ 20 ], whereas AHCs from Dhading, Ramechap, Rupandehi, and Rolpa had fewer study participants (Additional file 1 ).…”

“…Information on socio-demographic characteristics (age, gender, marital status, ethnicity, education, occupation and income), smoking, alcohol consumption, physical activity and the use of antihypertensive medication were collected before the intervention. We applied structured questionnaires to record socio-demographic characteristics, smoking and alcohol consumption related behaviours, and seven days history of physical activity as previously described in the protocol paper in detail [ 20 ]. We measured height and weight using portable stadiometers and digital weighing machines respectively.…”

Characteristics of Yoga Providers and Their Sessions and Attendees in the UK: A Cross-Sectional Survey

“…The Indian government initiated the Scheme for Voluntary Certification of Yoga Professionals, which is monitored by the Ministry of Ayush [ 19 , 20 ], and is creating a regulatory body for higher education and practice [ 21 , 22 ]. Similarly, Nepal has also established yoga as a health promotional tool for noncommunicable disease prevention and control [ 23 ]. Yoga is also popular in other parts of the world, including several high-income countries, such as Australia, Germany, and the U.S. [ 24 , 25 , 26 , 27 ].…”

Yoga for hypertensive patients: a study on barriers and facilitators of its implementation in primary care

“…Between 2017 and 2018, a clinical trial entitled ‘Impact of a structured yoga program on blood pressure reduction among hypertensive patients’ (YoH) was conducted in seven Ayurveda Health Centres in Nepal [ 27 ]. This trial was carried out to test whether a health-worker-led yoga intervention implemented in the clinical practice setting could effectively reduce blood pressure in hypertensive patients.…”